First EFIC® Symposium Societal Impact of Pain - SIP

Jose De Andrés
Prof. Jose De Andrés MD, PhD, FIPP
Qualified from the School of Medicine of the
Valencia University.
Current Positions and responsibilities:
• Associate Professor of Anaesthesiology of
the Valencia University School of Medicine.
• Chairman of Anaesthesia , Critical Care and
of the Multidisciplinary Pain Management
Departments in the Valencia University General
Hospital (Valencia, Spain).
• European Society of Regional Anesthesia and
Pain Therapy (ESRA): Treasurer, member of
the scientific committee and councillor of
Spain in the board of directors.
• European Federation of IASP Chapters (EFIC):
Councillor of Spain in the European council.
• Spanish Pain society (IASP Chapter): Director
of continuous medical education programme
• President of “Foundation for study and treatment
of pain of the Valencian community”
Member on editorial boards of national and
international journals in the field of Regional
Anaesthesia and Pain Medicine
Scientific Activity: publications, chapters and
collaborations in books specializing in conferences
oral presentations and research lines
relating to pain management.
Interventional therapeutic strategies for
the treatment of pain
The management of patients suffering from
chronic pain has proven to be a complex
process. Interventional and surgical techniques
should be considered when pharmacological
treatment supplemented with physical exercise
failed to provide adequate relief or induced unacceptable
side effects.
There are a multitude of interventional techniques
in the management of chronic pain, in-
cluding not only neural blockade but also minimally
invasive surgical procedures such as peripheral
nerve blocks, trigger-point injections,
epidural injections, facet joint injections, sympathetic
blocks, neuro-ablation techniques, intradiscal
thermal therapy, disc decompression,
vertebral reinforcement techniques like kyphoplasty,
morphine pump implantation, and spinal
cord stimulation.
The epidural administration of corticosteroids,
either by the interlaminar or transforaminal
route, allows precise application of corticosteroids
to the vicinity of the irritated nerve
root, resulting in massive concentration of the
agent at the site and its therapeutic effect for
the management of spinal pain has been investigated.
Radiofrequency (RF) techniques in the management
of different chronic pain syndromes is
based on interference in the conduction of
nociceptive stimuli. The electric field generated
around the electrode has the potential of producing
modification of neural structures and
neuronal behavior, which may also change pain
perception. Pulsed radiofrequency (PRF) was
introduced in clinical practice as a non- or minimal
neurodestructive modification of conventional
RF heat lesions.
Improvements in the understanding of Intrathecal
drug delivery (IDD) and the drive for
higher standards in implantation procedure,
combined with advances in technology and use
of novel drug combinations of drugs such as
baclofen and morphine or clonidine contribute
to successful treatment outcomes with IDD.
Spinal cord stimulation, also referred to as
SCS, has been applied successfully in a number
of indications, but is most often used to treat
postoperative neuropathic back and leg pain,
most commonly called failed back surgery syndrome
(FBSS), and complex regional pain syndrome
(CRPS); The efficacy of SCS in CRPS
and FBSS/CLBP has resulted in the technique
being used in other pain states, such as diabetic
neuropathy, post-traumatic neuralgia and
postherpetic neuralgia. Current applications of
electrical neuromodulation implies its use at
periferal nerves but also in field stimulation indications.
With all these possibilities interventional pain
procedures must be carefully selected and applied
for achieving the best care for our patients
and providing at the end intended quality
of life.
25